Annals of International Medical and Dental Research- Volume 5, Issue 4, July- August 2019

ISSN (0):2395-2822; ISSN (P):2895-2814

Study of ABO Blood Groups and Subgroups Aj, Az, AiB
and A2B in Blood Donors and Recipients

Ninder Kumar’, Neeraj Sharma’, Amarjit Singh?

1Assistant Professor, Department of Pathology, Government Medical College, Patiala.
Professor, Department of Blood Transfusion, Government Medical College, Amritsar.
3Professor, Department of Pathology, Government Medical College, Amritsar.

Received: April 2019
Accepted: May 2019

Copyright: © the author(s), publisher. It is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and
reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Blood transfusion in modern era is possible only due to the knowledge of exact blood groups and sub blood
groups. Over 700 erythrocyte antigens have been reported and are organized into 35 blood group systems by International
Society of Blood Transfusion. These antigens may be proteins, glycoproteins or glycolipids and are controlled by single or
more gene locus. Some antigens are specific to red cells; whereas, others are found on other cells throughout the body.
The ABO blood group was the first human blood group to be discovered by Landsteiner in 1900 and it served the beginning
of Blood Banking and Transfusion Medicine. Numerous mutations are found in A, B and O genes, but the most common
mutation is A2. The A2 gene has two nucleotides different from the A1 gene which results in diminished enzymatic activity
and consequently, weakened antigen expression. Distinction between A1 & A2 made by testing red cells with the lectin
from Dolichos biflorus. Prospective study on 2000 cases to find the frequency of ABO and sub blood groups to reduce the
blood transfusion related reactions. Methods: The present study included 2000 blood sample collected in the Department
of Blood Banking, Govt. Medical College and Hospital, Amritsar and in voluntary blood donation camps organized by the
department. 4 ml of venous blood sample collected. 2ml of blood put into ethylene diamine tetra acetic acid (EDTA) vial
and remaining 2ml transferred to test tube and allowed to clot. The EDTA sample used for forward grouping and serum
used for reverse grouping. Results: In our study the frequency of blood group B was the highest 37.8%, blood group O
was 31.8%, blood group A was 21.2% and group AB was the least common with 9.2%age. In case of sub groups, A1 was
20.10% (highest in sub groups) and A2B was 0.85% (Lowest). The Rh +ve blood group was 94.1% and Rh -ve was 5.9%.
Conclusion: The study is concluded with the suggestion that, as already being carried out, ABO, Rh blood grouping and
sub grouping should be done in each and every case to reduce the blood transfusion related complications. More work
should be carried out in different parts of state to know the distribution pattern of ABO, Rh blood groups and sub groups.
This will also help the Blood Banks to estimate the requirement of different blood groups and sub groups.

Keywords: Blood Group, Blood Transfusion.

INTRODUCTION

Blood transfusion in modern era is possible only due
to the knowledge of exact blood groups and sub
blood groups. Over 700 erythrocyte antigens have
been reported and are organized into 35 blood group
systems by International Society of Blood
Transfusion." These antigens may be proteins,
glycoproteins or glycolipids and are controlled by
single or more gene locus. Some antigens are
specific to red cells; whereas, others are found on
other cells throughout the body.! The ABO blood
group was the first human blood group to be
discovered by Landsteiner in 1900 and it served the

Name & Address of Corresponding Author
Dr Ninder Kumar
Assistant Professor,

Department of Pathology,
Government Medical College,
Patiala.

beginning of Blood Banking and Transfusion
Medicine. In 1902 Decasterllo and Struli discovered
the fourth type AB."! The expression of ABO
antigen is controlled by three separate genetic loci.
Numerous mutations are found in A, B and O genes,
but the most common mutation is A2. The A2 gene
has two nucleotides different from the Al gene
which results in diminished enzymatic activity and
consequently, weakened antigen expression."
Distinction between Al & A2 made by testing red
cells with the lectin from Dolichos biflorus."! The
incidence of ABO groups varies very markedly in
different parts of the world and in different races."!
Anti-A and anti-B are usually detectable within 3 to
6 months after birth." At the age of 5 years, the
titers of anti-A and anti-B antibodies reach
maximum and persist throughout adulthood. The
titers of IgM anti-A and anti-B antibodies may
gradually decline with advanced age.!!!) ABO
antibodies are a cause of hemolytic transfusion

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reactions, hemolytic disease of the newborn and
acute rejection in solid organ transplantation.”!

AIMS AND OBJECTIVES
The present study was taken up with the following
aims and objectives:

present on RBCs with commercial anti A and anti
B antisera respectively.
Serum Grouping:

. Reverse/Indirect or proof grouping is based on an
agglutination reaction between naturally occurring
anti A and anti B antibodies in serum/plasma with

1. To find frequency of ABO blood group system in reagent A or B red cells respectively.
the region. . Blood group A is further divided into Al and A2
2. To find out the frequency of sub groups Al A2 based on reaction with anti Al lectin (Dolichos
AJB and A2B in the region. biflorus). Based on this the ABO blood group
3. To find out the frequency of Rh positive and Rh system can be divided into six subtypes Al, A2, B,
negative in the region. A1B, A2B and O.
4. To reduce the incidence of transfusion related

e

. Forward/Direct

reactions by providing appropriate blood group to
recipient.

MATERIALS AND METHODS

The present study included 2000 blood sample
collected in the Department of Blood Banking, Govt.

RESULTS

In our study the frequency of blood group B was the
highest and group AB was the least common as
shown in [Table 1].

Table 1: Showing distribution of ABO blood groups

Medical College and Hospital, Amritsar and in Blood No. of cases %o age
voluntary blood donation camps organized by the Group

A 424 21.2%
department. 4 ml of venous blood sample collected. AB 184 9.2%
2ml of blood put into ethylene diamine tetra acetic B 7156 37.8%
acid (EDTA) vial and remaining 2ml transferred to O 636 31.8%
test tube and allowed to clot. The EDTA sample Total 2000 100%

used for forward grouping and serum used for
reverse grouping.

Principles of Blood Grouping:

Cell grouping:

grouping is based on an
agglutination reaction between A and B antigens

The above samples in addition to ABO and Rh were
also screened for sub groups of A and AB i.e. Al,
A2, A1B and A2B including their Rh blood group
typing. The final analysis of the cases shows the
frequencies as given in [Table 2].

Table 2: Showing Distribution of ABO Blood group, sub groups and Rh typing

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Blood Group & | Total no. of Percentage Rh +ve Rh-ve

Sub Blood cases

Group

Ai 402 20.10% 375 18.75% 27 1.35%
Ao 22 1.10% 21 1.05% 01 0.05%
A.B 167 8.35% 161 8.05% 06 0.30%
A.B 17 0.85% 16 0.80% 01 0.05%
B 756 37.80% 709 35.45% 47 2.35%
O 636 31.80% 600 30.00% 36 1.80%
Total 2000 100% 1882 94.10% 118 5.90%

blood group A2B —ve was least common ABO —ve
blood group [Table 2].

600
500
=Total
a ™Rh+ve
300 ™Rh-ve
A,B A,B
0.85% 8.35% 200
Figure 1: Showing distribution of ABO Sub groups. 100 |
oO = —— - :
Al A2 A1B A2B B ie)

Blood group B+ve was the commonest and A2B+ve
was the most uncommon among the ABO +ve blood
group. Blood group B —ve was commonest and sub

No. of cases
8

Figure 2: Showing ABO sub groups and Rh
distribution

Canals of Inteumational Medical and Dental Research, Vat (5), Josue (4) Page 6

DISCUSSION

The greatest challenge to the practice of safe blood
transfusion is by the transfusion — related
complications. A systematic plan of action is needed
to minimize these complications by proper
identification of blood groups and sub blood groups.
Moreover the distribution of ABO, Rh and sub blood
groups varies markedly in the different parts of the
world and so is in India which is very vast and
inhabited by different races and ethnic groups. The
quantitative information available regarding
distribution of blood groups in different Indian
regions is sufficient but the information regarding
prevalence of Al, A2, AIB and A2B sub groups, is
however less in different races and regions. The
present study was therefore undertaken and the
frequency of blood group B was found to be highest
with 37.8% while AB was lowest with 9.2%. In case
of sub groups, Al was 20.10% (highest amongst sub
groups) and A2B was 0.85% (Lowest). The Rh +ve
blood group was 94.1% and Rh —-ve_ was
5.9%.[Table 2]

Similarly various studies conducted by different
authors show blood group B predominance. Sidhu S
(2003),!°! Pande P and Singh M (2004),!'*! Devi OR
and Gangadhar M_ (2006),"71 Subhashini AB
(2007),"*! Various studies from Pakistan also shown
similar trend Hameed A et al (2002),"7! Anees M
and Mirza M (2005),""3! Khattak I et al (2008).""4!

In contrast however, some studies from different
regions of India show that the blood group O is most
prevalent which is followed by group B whereas AB
found to be least common. Dass PK et al (2001),
Prabhakar S et al (2005),?"! Latoo JA et al (2006),!!°!
Periyavan S et al (2010),'°?! All these studies are in
contrast with present study which shows the group B
predominance. So it was noted that the ABO blood
group distribution was different in different regions
of India. In present study Rh +ve was 94.1% and
Rh-ve in 5.9% cases whereas different studies from
different regions of India show Rh+ve predominance
over Rh-ve.(Gauniyal M),! (Meitei S. and
Kshatriya G),”°! Different studies reported sub blood
groups Al, A2, A1B, A2B, B, O and Rh blood
group and sub group distribution from different
regions of India are as shown in [Table 3].

Table 3: Showing comparative Al, A2, A1B and A2B and Rh studies in India

Author A % AB % B% O% Rh %

and Region of study

with year Al A2 AIB A2B +ve —ve
Mukhopadhyay R. and 22.5 0.83 11.67 0.83 40.0 24.17 92.5, 7.5
Kshatriya G.”> (HP)* 26.17 0.93 16.82 0.93 37.39 17.76 95.33 4.67
2004

Gauniyal M* (U)* 2006 | 40.69 1.13 11.86 0.57 22.03 23.72 67.24 32.76
Pattanayak P*(U)* 2006 | 38.54 0.98 10.24 0.48 25.85 23.91 77.00 23.00
Meitei S. and Kshatriya | 16.5 1.0 4.9 00 22.3 55.33 99.03 0.97
G* (DNH)* 2009 16.5 2.91 5.83 00 34.95 39.81 100 00
Giriyan S, Agrawal A?’ | 25.91 0.30 7.34 0.85 - - - -
(K)* 2017

Present study (P)* 20.1 ll 8.35 0.85 37.8 31.8 94.1 5.9

*HP- Himachal Pradesh, U- Uttaranchal, DNH- Dadra and Nagar Haveli, P- Punjab, K- Karnatka

Mukhopadhyay R. and Kshatriya G. studied the
distribution of blood groups among Brahmins and
Rajputs of Himachal Pradesh and found that blood
group B was highest while among sub groups Al
was most common whereas A2 and A2B was least
common.”3! Another study conducted in North
Karnatka by Giriyan S. and Agrawal A.27! shows
predominance of Al and A2 least common and
present study shows almost similar results with Al
preponderance.

Pattanayak I. concluded in distribution of Al, A2,
B,O and Rh among the Rajputs of Uttaranchal that
blood group A was most prevalent followed by
group B which is in contrast to present study
however subgroups distribution Al was highest
while sub group A2B was the rarest.'*4! Gauniyal M.
in study of blood group Al, A2, B,O and Rh among
Brahmins of Mussoorie Uttaranchal found that blood
group A was most common among sub group Al
was the highest with 40.69% and A2B was lowest
with 0.57%.°!_ Sub groups findings _ well
concordance with present study.

Meitei et al studied that distribution of Al, A2, B,O
and Rh among the rajputs and Warlis, Dadra and
Nagar Haveli, in Rajputs and Warlis sub group Al
was 16.5% while no case related to A2B was
found. The Group O was the highest in both the
populations.”°! All these findings are in contrast to
present study.

In the light of above facts it is suggested that there is
significant difference in the distribution of ABO
blood groups and sub groups in the different regions
of our country. As a whole Blood group O is most
prevalent followed by group B, However in north
India (Punjab) group B is more common followed by
group O. In all the study groups, sub group Al was
found to be most common and A2B was the least
common.

CONCLUSION

The study is concluded with the suggestion that, as
already being carried out, ABO, Rh blood grouping
and sub grouping should be done in each and every

Annals of Intemational Medicat and Dental Research, Val (5), Josue (4)

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case to reduce the blood transfusion related
complications. More work should be carried out in
different parts of state to know the distribution
pattern of ABO, Rh blood groups and sub groups.
This will also help the Blood Banks to estimate the
requirement of different blood groups and sub

groups.
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How to cite this article: Kumar N, Sharma N, Singh A.
Study of ABO Blood Groups and Subgroups A1, A2, A1B
and A2B in Blood Donors and Recipients. Ann. Int. Med.

Den. Res. 2019; 5(4):PTO5-PT08.

Source of Support: Nil, Conflict of Interest: None declared

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